Sarah Hughes PT, DPT, OCS, CF - L2 has been a practicing physical therapist since 2007 and opened her private practice Arrow Physical Therapy in 2016. She now owns and operates Arrow remotely while residing in the Chicago area and practicing at Outlier Physical Therapy. Her specialties include dance medicine, the CrossFit and weightlifting athlete, and conditions of the hip and pelvis such as femoroacetabular impingement and labral tears. Dr. Hughes earned a BS in exercise science from Gonzaga University and a DPT from the University of Washington, she wrote and instructs Weightlifting and Functional Fitness Athletes.
Modifying exercise, particularly CrossFit and weightlifting exercises, when pregnant is critical to reducing your risk for injury. It’s hard to do for sure. We all want to maintain our fitness and remain competitive. But, the priority during and after pregnancy is the safety and health of both baby and the birthing person.
Remember, just because you aren’t in pain or you are still capable of performing in the way you did pre-pregnancy, you may be doing yourself a disservice by setting yourself up for problems down the line, or at the very least some bad habits as you change your technique with various movements.
Of course, we are not discouraging exercise. In fact, please continue to exercise!! But, just use your best judgment and consider the ways in which you might modify your workouts during your pregnancy.
Below are modification examples:
MODIFY OLYMPIC LIFTS:
- Start at the “hang” positions: Modify the lifts by starting from the hang position when the belly increases in size, as this makes it harder to lower the barbell to the ground.
- Finish in the “power” position: Often pregnant people don’t feel comfortable catching in the squat position. You can still work these barbell movements by catching in power positions.
- Forego the barbell: Finally, when the size of the pregnant belly starts to change the bar path (ie. you are swinging that weight way out in front to avoid hitting your bump), consider switching to dumbbells or kettlebells for the Olympic lifts. An improper bar path leads to bad habits and can cause injury.
MODIFY OTHER STRENGTHENING LIFTS:
The biggest thing to note here is that there is no reason to be doing max efforts when you are pregnant. You are probably not going to be setting any records and the cost/benefit may not end up being worth it. However, that is not to say you shouldn’t be lifting, or even lifting heavy. Just be sure that you are managing your breathing and not creating too much pressure with these lifts. You need to be exhaling as you exert effort so as to avoid bearing down into the pelvic floor and abdominals.
A few specific notes:
- when it comes to moving weight overhead, be sure that you are not over-arching your back and instead keeping the weight manageable so that you can maintain the best form.
- if squatting feels vulnerable because the bottom of the position feels weak, you can squat to a box to limit the range of motion. You will still be able to strengthen while protecting your body from an unstable position.
- when deadlifting, really think about dialing weight back in order to avoid using a bearing down Valsava maneuver.
MODIFY KIPPING MOVEMENTS:
Pregnant or postpartum people may experience a “separation” of the abs which we call a diastasis recti. Diastasis recti is caused by a stretching of the linea alba, the tissue that connects the left and right halves of the rectus abdominis muscle. This is a very common condition caused by the growing uterus expanding against the abdominal muscles.
This can happen naturally, just by nature of the abdomen growing. However, if you have a weak core wall or are not properly engaging it during a kipping motion, you might be making the condition worse. It’s not necessarily that you aren’t skilled enough to do the movement, but rather that your core is stretched out (thanks baby!) and the muscles are unable to contract appropriately after a certain point. By continuing to kip when this is the case, you are risking over-stretching your core wall.
- Kipping motions include: pulls up, muscle-ups, toe-to-bars, knees to elbows & knee raises.
- Modify by doing strict motions (band them as needed).
- Pull-ups can be further modified with ring rows.
- Toes-to-bar and knees-to-elbow can take a back seat. Perform Russian swings with a kettlebell if you want a metabolic stimulus and planks if you want a core stimulus.
- The ability to kip will return. You aren’t losing out on anything.
MODIFY MUSCLE UPS:
Muscle Ups: same as above. Let’s stay strict and no Valsalva maneuver. You want to avoid pressure bearing down on the pelvic floor.
If these modifications are out of reach, you can practice muscle-up transitions from your toes or using a band. You can also modify with jumping muscle-ups (stick to the ring as you won’t want your belly to hit that bar).
MODIFY PLANKS AND HOLLOW HOLDS:
If you cannot feel your abs engaging, chances are that they aren’t. You can try side planks perhaps or planks on an elevated surface. At some point, you might just cut them out of your program.
MODIFY BURPEES:
Step out to a plank and back up. You can also do an incline push-up using a bench, plates or boxes. If you are adding a jump over a barbell or other apparatus consider stepping over to avoid a potential fall and to minimize the impact through the pelvis. If burpees lead to incontinence or an “urge sensation”, modify.
A quick guide to common movement substitutions:
- Kipping Pull-Up = controlled kipping without pull-up, strict pull-up, or ring row.
- Kettlebell Swing = may modify to single arm swing for comfort on the back swing, may modify to Russian swing.
- Deadlift = sumo or kettlebell deadlifts may be more comfortable.
- Sit Ups = plank, pallof press, slam ball, side plank, hanging knee raise.
- Bench Press = press, push up (elevated as necessary).
- Handstand Push Up = modified pike on box or floor, dumbbell or barbell press/push press.
- Box Jump = lower box at first, and then step up.
- Snatch/Clean =hang power versions, then dumbbells as necessary once the belly is in the way. Can perform the power version of the movement and then squat under control. Moderate load deadlifts are also a great sub.
- Jump Rope/Running = as far as your level of comfort allows. Rowing is a good sub. Kettlebell swings and/or slam ball for a similar metabolic effect.
- Thrusters/Wall Ball = controlled squat and presses either with a barbell or dumbbells.
- Push Ups/Burpees = on a raised surface like a box, parallettes or a bar in a squat rack.
Of course, there are many many other modifications and these are not meant to be medical advice. Talk to your physical therapist or coach and listen to your body!
Sarah Hughes' original article can be found on the Arrow Physical Therapy website at https://www.arrowptseattle.com/news/crossfitmodificationsforpregnancy.
Weightlifting and Functional Fitness Athletes - October 14, 2023
Price: $295
Experience Level: Beginner
Contact Hours: 9
Description: When it comes to Crossfit and Weightlifting, opinions are divided among Physical Therapists and other clinicians. Why is it that these sports cause such strong differences among rehab professionals? In this half-day, remote continuing education course, instructor Sarah Haran PT, DPT, OCS, CF-L2 looks at the realities and myths related to Crossfit and high-level weight-lifting with the goal of answering “How can we meet these athletes where they are in order to keep them healthy, happy and performing in the sport they love?" This course will review the history and style of Crossfit exercise and Weightlifting, as well as examine the role that therapists must play for these athletes. Common orthopedic issues presented to the clinic will be examined. However, while things like urinary function, pregnancy and postpartum, hip impingement, LBP/pelvic pain, prolapse, and diastasis will be touched on, this will not be a course in addressing pelvic health concerns in these athletes. These topics will be more fully addressed in the course: Pregnancy and Postpartum Considerations for High-Intensity Athletics with Emily McElrath.
Labs will introduce and practice the movements of Crossfit and Weightlifting, discussing the points of performance for each movement. The practitioner will not only learn how to speak the language of the athlete but will experience what the movement feels like so that they may help their client to break it down into its components for a sport-specific rehab progression. The goal of this course is to provide a realistic breakdown of what these athletes are doing on a daily basis and to help remove the stigma that this type of exercise is bad for our patients. It will be important to examine the holes in training for these athletes as well as where we are lacking as therapists in our ability to help these individuals. We will also discuss mindset and culture issues such as the use of exercise gear (i.e. straps or a weightlifting belt), body image, and the concept of "lifestyle fitness". Finally, we will discuss marketing our practices to these patients.